The patient complains of redness, swelling, and pain in the eyelid, perhaps at the base of an
eyelash (sty or external hordeolum) or deep within the lid (meibomianitis or internal
hordeolum, best appreciated with the lid everted) perhaps with conjunctivitis and purulent
What to do:
Examine the eye, including visual acuity and inversion of lids (see "Conjunctival FB" for
Show patient how to instill antibiotic drops or ointment (e.g., sulfa, tobramycin,
erythromycin, gentamycin) into his lower conjunctival sac and apply warm tap water
compresses for 10 minutes per hour or 20 minutes four time daily.
Instruct the patient to return to the ophthalmologist or the ED if the problem is not clearly
resolving in two days, or if it gets any worse.
If the abscess does not spontaneously drain or resolve in two days, you may incise it with
the tip of a #11 blade or small needle, with the same follow up instructions.
What not to do:
Do not miss a periorbital cellulitis, which is a severe infection and requires agressive
systemic antibiotic treatment.
The terminology of the two types of hordeolum have become confusing. Meibomian glands
run vertically, within the tarsal plate, open at tiny puncta along the lid margin, and secrete oil
to coat the tear film. The glands of Zeiss and Moll are the sebaceous glands opening into the
follicles of the eyelashes. Both can become occluded and superinfected, producing
meibomianitis (internal hordeolum) or a sty (external hordeolum). The ED care of both acute
infections is the same. A chronic granuloma of the meibomian gland is called a chalazion,
will not drain, and requires excision.